P1016Importance of multiplanar real-time intraoperative TEE in endovascular treatment of iatrogenic pulmonary vein stenosis. Twelve cases review. Single centre experience.


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Abstract

Purpose: PVS constitutes a rare but serious complication of catheter ablation of arrhytmogenic foci within pulmonary veins and surrounding atrial tissue. TEE represents a sensitive, non-invasive, bed-side imaging modality for pulmonary vein diseases. Percutaneous stent placement presently offers most effective iatrogenic PVS treatment. Through our centre's experience with the use of multiplanar real-time TEE in planning and execution of endovascular PVS treatment we would like to contribute to management optimization of this tricky chronic disease.Methods and Materials: Twelve PVS interventions were performed using multiplanar real-time TEE supplementing angiography for transeptal puncture guidance, PV ostia depiction, lesions identification and quantification, stent positioning and subsequent blood-flow visualization and cardiac function monitoring.Results: Intraoperative multiplanar real-time TEE has proved to be a valuable complimentary tool for transeptal puncture guidance, lesion visualization, stent placement through providing crucial spatial information about the atria, foramen ovale, PV ostia, pre-and-post procedural pressure and velocity gradients, in-stent blood-flow monitoring in all 12 cases of PVS interventions. TEE also offered useful information regarding cardiac function during the procedures.Conclusion: Multiplanar real-time intraoperative TEE has in our centre proved to be an essential supplement to angiography significantly increasing their safety, accuracy, and efficacy through providing fast and complete pathomorphological information, improving spatial orientation, allowing continuous monitoring of the procedures and thus improving their outcomes and not less importantly lowering radiation dose and contrast material use.

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